Multiple Indicator Cluster Survey 1995

Questionnaire: The following questionnaire modules from the Practical Handbook for Multiple-Indicator Surveys were slightly modified and used as the questionnaire for the survey:

1. Mortality: Except incomplete epidemiological reports from few health facilities, there is no estimate on the level of under five mortality in Liberia since 1986. Due to the significant changes, caused by the civil war, it is believed that the mortality rate would be higher. The MICS Coordinating Committee decided to include the module on mortality on the hope of getting some rough estimate on the level of under five mortality. Unfortunately, however, we cannot compute the data with existing programmes. Attempts are being made to use other programmes like “Mortpak” to analyze the data. The report on mortality would, therefore, be prepared later as an addendum to this report.

2. Water and Sanitation: The module on water and sanitation was used without much modification to get estimates on water and sanitation coverage, which otherwise are not available from other routine sources. However, the data collected from the two regions (Region 11 and III) were later on discarded as most of the residents in the two regions are displaced people and the questionnaire did not capture their situation. In areas where most displaced people live, existing water and sanitation facilities are being used by too many people which makes the facilities extremely unhygienic. There was no question to capture this reality, and the results obtained could be misleading. After discussions with professionals in the sector, it was decided that the results from the two regions will not be reported.

3. Education: The module was used as it is without revision. At the analysis stage, definitions appropriate to the Country were adopted (the definitions are discussed under “Findings” on education).

4. For Mothers: The Tetanus Toxoid and the Care of Acute Respiratory Infection (ARI) modules were included in the questionnaire. Mothers' knowledge of ART is important for design of health programmes since ARI is one of the three major causes of morbidity and mortality in Liberia.

5. For Children under Five Years of Age: All the modules for children, i.e. Diarrhoea, Breast-feeding, Immunization, and Anthropometry were included in the questionnaire since all of them were extremely relevant for the situation in Liberia. In fact, in the anthropometry module, we included the measurement of height/length to be able to compute acute malnutrition, despite its heavy implication on costs. Since Liberia is an emergency country, more accurate data on the nutritional status of children are very important for programme purposes. In addition, available nutrition data, though scattered, in the emergency period are based on Weight for Height and we want this survey to generate data which can be compared to previous studies.

These modules were selected with the consent of the epidemiologist from the Ministry of Health and Social Welfare and UNICEF experts in the areas of health, education and water and sanitation.

The Vit. A module was not included as there is no genera1 Vit. A supplementation programme in the Country. Vit. A supplement, with measles vaccination, is given only for selected groups - primarily for children in newly accessible areas (these are areas which become accessible after being isolated for many months due to fighting). Normally, Vit. A deficiency was not a significant health problem before the war due to the availability of Vit. A rich local food. We are planning to conduct a clinical survey to know the extent of the problem after the war.

The module on salt iodization was also not included in the survey. In 1994 a market survey was done in six counties to test the presence of iodine in all brands of salt. That test showed that all brands of salt in the Liberian market do not contain iodine. Since all Liberian households consume one or another of the brands tested, we believe that testing at a household level is unnecessary.